Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

New Developments in Alleviating Anxiety

GOALTo provide primary care physicians with current information regarding the diagnosis and treatment of patients with anxiety disorders.

TARGET AUDIENCEThis activity is designed for primary care physicians. No prerequisites required.

PROGRAM RATIONALEAnxiety disorders are the most prevalent of psychiatric disorders; analyses of the largest prevalence studies of psychiatric illnesses in the United States find that anxiety disorders afflict 15.7 million people in the United States each year, and 30 million at some point in their lives.

Anxiety disorders, such as generalized anxiety disorder, impose high individual and social burden, tend to be chronic, and can be as disabling as somatic disorders. Generalized anxiety disorder often goes unrecognized in primary care as a result of many factors: insufficient knowledge on the part of the physician, time pressures, and competing demands during patient visits; patient misattribution of symptoms and the stigma associated with mental illness; the natural history of generalized anxiety disorder; the bimodal age of presentation; a chronic but waxing and waning course; frequent comorbidity with other anxiety and depressive disorders; and the controversy regarding the best diagnostic criteria. Compared with patients who have other psychiatric disorders, those with anxiety disorders present to general practitioners more frequently than to psychiatric professionals, making detection and appropriate treatment by primary care physicians essential. This issue of Advanced Studies in Medicine will provide primary care physicians with valuable information regarding diagnosis of anxiety disorders, with a focus on generalized anxiety disorder, as well as information regarding new treatments for anxiety.

LEARNING OBJECTIVESThe Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this activity. At the conclusion of this activity, the participant should be able to:

Understand information regarding the diagnosis and treatment of anxiety disorders in the primary care setting.

Recognize the benefits and risks of new treatments for anxiety.

DISCLAIMER STATEMENTThe opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Forest Pharmaceuticals, Inc.

Full Disclosure Policy Affecting CME Activities:As sponsors accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Council on Pharmaceutical Education (ACPE), it is the policy of Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

Notice:In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty members have disclosed the reference to the following unlabeled/unapproved uses of drugs or products:

Drs Culpepper and Davidson - Use of SSRIs and newer antidepressants for anxiety spectrum disorders.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or products.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

New Developments in Alleviating AnxietyO. Joseph Bienvenu, MD, PhD

Anxiety disorders are common in the general population and are particularly common in the primary care setting; many patients present to their primary care physicians because of the physiologic symptoms associated with the disorders. Four anxiety disorders are especially common in primary care; in order of lifetime prevalence they are: social anxiety disorder, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder.

Generalized anxiety disorder is the most common anxiety disorder in patients presenting to the primary care physician, and it is rarely recognized. Seeing past the somatic symptoms that accompany all of the anxiety disorders is important for proper diagnosis and treatment.

Many treatments are available for anxiety disorders, with the ultimate goal of complete remission. Serotonergic antidepressants have recently been recognized as important drugs for long-term control; maximum benefits are derived from such long-term treatment regimens. Studies have shown that stopping treatment prematurely can lead to relapse. Appropriate treatment of anxiety disorders will also improve the patient's quality of life, another major goal of therapy.

This issue of Advanced Studies in Medicine provides the primary care physician with practical insight into the diagnosis and treatment of 4 of the most common anxiety disorders: generalized anxiety disorder, posttraumatic stress disorder, social anxiety disorder, and panic disorder. The contents of this issue were prepared based on the opinions of 2 experts, Jonathan R. T. Davidson, MD, Director of the Anxiety and Traumatic Stress Program at Duke University Medical Center, and Larry Culpepper, MD, MPH, Chief of Family Medicine at Boston University Medical Center, expressed in their presentations at a recent symposium on treating anxiety in primary care.